Despite investments in research, in training, in equipment and infrastructure, survival from unexpected cardiac arrest has been virtually unchanged over the past couple of decades. On average, the survival rate is approximately 5% in USA/Europe, but can even be as low as 2% in the bigger cities, or well above 20% in those cities with the best implementation of science and education.
One factor influencing survival is time elapsed from cardiac arrest onset until professional treatment begins. This time varies a lot. It is known that the vital organs can sustain approximately 5-10 minutes without perfusion before resuscitation becomes effective, and after that time the chance of survival is reduced by about 5-10% for every minute, so that after about 15 to 20 minutes survival chances are very small.
There is thus a need for expanding the time window of opportunity of recovering from cardiac arrest.
One other factor of survival is that current treatment of chest compressions, ventilations, defibrillation and drugs does not address the underlying cause of the arrest. Some hearts are simply too compromised to be restarted, even though CPR, drugs and defibrillation are delivered according to best practice. Many patients who do not receive return of spontaneous circulation within some minutes of resuscitation attempts could benefit from receiving continuous CPR to keep vital organs intact, followed by application of some external means of circulation to buy enough time so that corrective treatment can be done in the hospital.
Another factor affecting survival is reperfusion injury. Cell death does not only take place as a result of ischemia, but also as a function of reperfusion. Given the situation of sudden cardiac arrest, most of the cell death and subsequent irreversible organ damage may take place when perfusion is restored because of the circulation of toxic components that have built up during ischemia. This is described for example by Vanden Hoek, et. al. “Reperfusion, not simulated ischemia, initiates intrinsic apoptosis injury in chick cardiomyocytes”, Am J Physiol Heart Circ Physiol, 284:H141-H150, 2003.
One factor that can improve survival is induced hypothermia. Therapeutic hypothermia can be beneficial after cardiac arrest, and intra-arrest cooling can be beneficial with both respect to defibrillation success and survival to discharge from hospital. Cooling also seems to slow down the speed of cell death caused by reperfusion after cardiac arrest. This is for example described by Abella, et al. in “Intra-Arrest Cooling Improves Outcomes in a Murine Cardiac Arrest Model.”, Circulation 2004; 109; 2786-2791.
The most used way to increase the time window is to perform cardiopulmonary resuscitation (CPR) on the victim of cardiac arrest. CPR is a procedure performed as life-saving first aid in case of a sudden cardiac arrest. The procedure comprises chest compressions and ventilation. There are, however, limits to this method. The person performing CPR may not be sufficiently skilled or motivated, there are difficulties performing CPR in an ambulance, there may not be enough rescuers available to perform CPR while performing other necessary activities at the same time, it is difficult to perform CPR over a long period of time, and the effectiveness of CPR to generate flow is also reduced by time.
This has led to a need for emergency cardiopulmonary bypass (eCPB). Cardiopulmonary bypass (CPB) (also sometimes referred to as heart-lung machine) is a technique that temporarily takes over the function of the heart and lungs during cardiac arrest. This has traditionally been used in hospitals during surgery, for induction of total body hypothermia, as life support for newborns with serious birth defects, or to oxygenate and maintain recipients for organ transplantation until new organs can be found. Such traditional machines are typically not suited for emergency use, as they are not portable, they require particular skills to operate and are not easily transported to the location where a cardiac arrest or trauma victim is located. But there is now a growing application of CPB even for cardiac arrest patients.
U.S. Pat. No. 5,308,320 describes a portable and modular cardiopulmonary bypass apparatus that can be transported to an accident scene or heart attack victim. The apparatus comprises balloon catheters which are used to distribute the blood flow to specific parts of the body, for example to administer medication only to some parts of the body.
US Published Application 2005/0027231 describes a mobile heart-lung machine which comprises two separate modules. One module comprises elements which circulate the blood, receive the biochemical and physiological signals and implement the control signals, this is a so-called “disposable module”. The other module comprises drive and automatic control elements, a so-called “reusable module”. This two-module design enables quick re-use of the machine.
These cardiopulmonary bypass apparatuses have an oxygenator in the bypass circuit which transfers oxygen to infused blood and removes carbon dioxide from the venous blood, that is, gas exchange occurs. The oxygenator is a risk factor of these apparatuses, as the blood is exposed to a huge surface area of the oxygenator and may coagulate. The oxygenator is also large and makes the apparatus large and complex and more costly in use.
U.S. Pat. No. 4,756,705 describes a heart-lung system that uses the patient's lungs as an oxygenator. The heart and lungs are coupled in two circuits, collecting blood from the heart in a venous reservoir, sending it through the lungs, and collecting the oxygenated blood in an arterial reservoir where it is warmed and sent into the body.
This is a complicated system with a plurality of catheters, two separate pumps for pumping the blood into the body and two separate blood reservoirs. This system will not be suited for emergency use and is not portable.